Diabetes For Ems Providers
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Humongous Insurance
Diabetes
Diabetes (Terms) Diabetes mellitus – (DM) A chronic disease characterized by an altered relationship between sugar (glucose) and insulin.
Diabetes Insulin – A hormone secreted by the pancreas that is needed to promote the movement of glucose (sugar) from the blood into the cells. Glucose – A simple form of sugar, the body’s main source of energy.
Diabetes Type I (IDDM)- Insulin dependent diabetes mellitus, usually acquired in childhood, produce no insulin (inheritable, auto-immune)
Requires insulin administration
Diabetes Type II (NIDDM) – Non-insulin dependent diabetes mellitus, usually acquired in adulthood (related to overweight), produce some insulin – not enough, or tissue sensitivity diminished
Can be controlled by diet, exercise, oral meds
Role of the Pancreas Primary role is the regulation of blood glucose concentrations.
Diabetes Role of the Pancreas Islets of Langerhans produce insulin Alpha cells – Glucagon Beta cells – Insulin Delta cells – Somatostatin (inhibits the secretaries of growth hormone)
Islets of Langerhans
Diabetes Beta Cells Insulin
Increase glucose transport into the cell Increase liver glycogen levels (storage) Decrease blood glucose concentration Glucagon Antagonist
Diabetes Alpha Cells Glucagon –
Released when blood sugar levels drop Increase blood glucose levels Breaks down fats and fatty acids (storage removal) Insulin Antagonist
High/Low Blood Sugar
Diabetes Glucagon Triggered by exercise, stress, sleep, hypoglycemia Insulin antagonist (decreases insulin’s actions)
Diabetes Long Term Effects Blindness Kidney disease Peripheral neuropathy Heart disease and stroke (atherosclerosis)
HD: 2X - 4X non-diabetic S: 2X - 6X non-diabetic
Limb amputations
Diabetes Hyperglycemia – Lack of insulin, glucose cannot enter the cells. Remains in the blood stream increases the level of blood sugar.
Hypoglycemia (Insulin Shock) – Lack of glucose in the blood stream, cells deprived of glucose.
Normal sugar level – 80-120 mg/dL
Diabetes Onset Type I – May occur at birth, usually occurs in teenage or young adult years
Typically a sudden onset of Polyuria (excessive urination), Polydipsia (excessive thirst), Polyphagia (excessive ingestion of food), dizziness, blurred vision, rapid and unexplained weight loss.
Diabetes Onset Type II –
Generally occurs in patients older than 40 y/o
Overweight patients Same onset S/S as Type I and fatigue, changes in appetite.
Get Off Me Woman!!!
Diabetes Hypoglycemia (Insulin Shock) Hypo (Low), Glyce (Sugar), Emia (Blood)
Excessive response to glucose absorption – – – – –
Physical exertion Alcohol Drug effects Pregnancy Poor dietary intake
Diabetes Hypoglycemia (Insulin Shock) Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Diabetes Hypoglycemia (Insulin Shock) Too much insulin Decreased dietary intake (missed meal) Vigorous activity
Diabetes Hypoglycemia (Insulin Shock) S/S Rapid onset Nervousness Irritability Combative behavior Weakness Confusion
Appearance of intoxication Weak, rapid pulse Cold, clammy skin Drowsiness Seizures
Coma (severe case)
Hyperglycemia Hyper (High), Glyce (Sugar), Emia (Blood) Slow onset Absence or lack of insulin Glucose accumulates in the blood Cells are starved
Search for alternate fuel
Excessive urination (dehydration)
Hyperglycemia Diabetic Ketoacidosis Results in a low pH (acidosis)
Fruity breath
Vomiting, dehydration, altered electrolyte balance, seizures Abnormal breathing pattern.
Kussmaul respirations
Deep & fast
Warm, dry skin
Hyperosmolar Hyperglycemic Nonketotic Life-threatening emergency Older patients with type 2 diabetes or undiagnosed diabetics Causes Precipitating factors Signs and symptoms
Pathophysiology of HHNK Coma
Diabetic Emergency Management Scene Size Up / BSI Initial Assessment
LOC ABC’s C/C Priority/Transport
Diabetic Emergency Management Focused History and Physical Examination/Rapid Assessment
Responsive - Focused Unresponsive – Rapid Medical Assessment
OPQRST SAMPLE
Diabetic Emergency Management OPQRST – – – – – –
Onset Provocation Radiating Quality Severity Time
SAMPLE – – – – – –
Signs & Symptoms Allergies Medications Past Medical Hx Last oral intake Events Leading to 911 call
Diabetic Emergency Management Common Meds identified in SAMPLE: – – – – –
Insulin Diabanese Orinase Micronase Diabeta
– – – – – –
Glynase Tolinase Glucotrol Humalog Rezulin Glucophage
Diabetic Emergency Management Treatment – High flow oxygenation (BVM vs. NRB)
– Suction Oral/nasal airway
Diabetic Emergency Management Can the Patient Swallow?
If so, oral glucose PO If not, NPO, rapid transport
Oral glucose:
Raises the blood sugar, may take as long as 20 min. Indications – Altered mental status, history of diabetes, ability to swallow Page 475
Oral Glucose Drug Sheet
Oral Glucose Class: Carbohydrates Route: Oral Supplied: Squeezable Tubes Dose:
Adult: Full Tube (25-50gm) given in small doses Pediatric: 0.5 gm/kg given in small doses
Oral Glucose Cont. Drug Action: Increases Blood Glucose Level Indications:
Altered mental status caused by hypoglycemia: Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Oral Glucose Cont. Precautions:
Assure gag reflex is present
Side Effects: Aspiration Contraindications:
Absent gag reflex Patents unable to protect their airway Patents unable to swallow.
Diabetic Emergency Management Baseline Vital Signs (Q 5 or 15 min) Detailed Patient Assessment Ongoing Assessment
ABC LOC Consider other causes
Scenarios
Scenario 1 Dispatched to an unconscious person. 32 y/o female. She has a history of DM. S/S – Sudden onset of altered LOC, did not eat supper, cool moist skin, rapid thready pulse, did take insulin.
What is the level?
What is wrong with her?
Hypoglycemic Treatment – – – –
High flow oxygenation Suction Oral/nasal airway if needed Oral glucose PO if able to swallow If not, rapid transport
Scenario 2 Dispatched to a 46 y/o old male. Large patient, family brings meds to you. They include Diabeta. Patient has not been feeling well for the past day or so.
Scenario 2 S/S: Rapid and deep respirations, skin warm and dry, dry mucous membranes, patient exhibiting bizarre behavior, pulse rapid and thready, history of Polyuria, Polydypsia, and Polyphagia.
What is wrong with him?
Hyperglycemia or DKA Treatment: – High flow oxygenation – Anything else? – Rapid transport
Scenario 3 Dispatched to 80 y/o for altered mental status. History of diabetes that is normally controlled with insulin. S/S: Nausea, vomiting, irritability, altered mental status, weak, rapid pulse, and no range of motion of the right side of body.
What is wrong with her?
CVA or Stroke Treatment:
– High flow oxygenation – Anything else? – Rapid transport
Other factors to consider Intoxication Other causes of AMS
Glucometer A device used to determine blood glucose levels.
Indications for blood sugar analysis Altered Mental Status Unconscious patients of unknown cause Suspected diabetic patients
Procedure Clean finger with alcohol Wipe dry Wipe away first drop of blood Use second drop of blood
Abnormal Glucose Values Outside the normal range (60-120)
Hyperglycemia – Greater than 300 Hypoglycemia – Less than 60
Conditions Diminishing Accuracy Margin of error (1015%) Missing calibration Temperatures Outdated strips Improper technique
Insufficient sample size Contamination Wrong sample source Neonates
Review
Review IDDM
Insulin Dependant Diabetic Type I
Review NIDDM
Non-insulin Dependant Diabetic Type II
Review
3 P’s Polydipsia Ployphagia Polyuria
Review Hypoglycemia Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Review Hyperglycemia
>120 mg/dl
Review DKA
Diabetic Ketoacidosis Kussmaul Respirations D-stick normally > 350 mg/dl
The End
Questions?
Diabetes
Diabetes (Terms) Diabetes mellitus – (DM) A chronic disease characterized by an altered relationship between sugar (glucose) and insulin.
Diabetes Insulin – A hormone secreted by the pancreas that is needed to promote the movement of glucose (sugar) from the blood into the cells. Glucose – A simple form of sugar, the body’s main source of energy.
Diabetes Type I (IDDM)- Insulin dependent diabetes mellitus, usually acquired in childhood, produce no insulin (inheritable, auto-immune)
Requires insulin administration
Diabetes Type II (NIDDM) – Non-insulin dependent diabetes mellitus, usually acquired in adulthood (related to overweight), produce some insulin – not enough, or tissue sensitivity diminished
Can be controlled by diet, exercise, oral meds
Role of the Pancreas Primary role is the regulation of blood glucose concentrations.
Diabetes Role of the Pancreas Islets of Langerhans produce insulin Alpha cells – Glucagon Beta cells – Insulin Delta cells – Somatostatin (inhibits the secretaries of growth hormone)
Islets of Langerhans
Diabetes Beta Cells Insulin
Increase glucose transport into the cell Increase liver glycogen levels (storage) Decrease blood glucose concentration Glucagon Antagonist
Diabetes Alpha Cells Glucagon –
Released when blood sugar levels drop Increase blood glucose levels Breaks down fats and fatty acids (storage removal) Insulin Antagonist
High/Low Blood Sugar
Diabetes Glucagon Triggered by exercise, stress, sleep, hypoglycemia Insulin antagonist (decreases insulin’s actions)
Diabetes Long Term Effects Blindness Kidney disease Peripheral neuropathy Heart disease and stroke (atherosclerosis)
HD: 2X - 4X non-diabetic S: 2X - 6X non-diabetic
Limb amputations
Diabetes Hyperglycemia – Lack of insulin, glucose cannot enter the cells. Remains in the blood stream increases the level of blood sugar.
Hypoglycemia (Insulin Shock) – Lack of glucose in the blood stream, cells deprived of glucose.
Normal sugar level – 80-120 mg/dL
Diabetes Onset Type I – May occur at birth, usually occurs in teenage or young adult years
Typically a sudden onset of Polyuria (excessive urination), Polydipsia (excessive thirst), Polyphagia (excessive ingestion of food), dizziness, blurred vision, rapid and unexplained weight loss.
Diabetes Onset Type II –
Generally occurs in patients older than 40 y/o
Overweight patients Same onset S/S as Type I and fatigue, changes in appetite.
Get Off Me Woman!!!
Diabetes Hypoglycemia (Insulin Shock) Hypo (Low), Glyce (Sugar), Emia (Blood)
Excessive response to glucose absorption – – – – –
Physical exertion Alcohol Drug effects Pregnancy Poor dietary intake
Diabetes Hypoglycemia (Insulin Shock) Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Diabetes Hypoglycemia (Insulin Shock) Too much insulin Decreased dietary intake (missed meal) Vigorous activity
Diabetes Hypoglycemia (Insulin Shock) S/S Rapid onset Nervousness Irritability Combative behavior Weakness Confusion
Appearance of intoxication Weak, rapid pulse Cold, clammy skin Drowsiness Seizures
Coma (severe case)
Hyperglycemia Hyper (High), Glyce (Sugar), Emia (Blood) Slow onset Absence or lack of insulin Glucose accumulates in the blood Cells are starved
Search for alternate fuel
Excessive urination (dehydration)
Hyperglycemia Diabetic Ketoacidosis Results in a low pH (acidosis)
Fruity breath
Vomiting, dehydration, altered electrolyte balance, seizures Abnormal breathing pattern.
Kussmaul respirations
Deep & fast
Warm, dry skin
Hyperosmolar Hyperglycemic Nonketotic Life-threatening emergency Older patients with type 2 diabetes or undiagnosed diabetics Causes Precipitating factors Signs and symptoms
Pathophysiology of HHNK Coma
Diabetic Emergency Management Scene Size Up / BSI Initial Assessment
LOC ABC’s C/C Priority/Transport
Diabetic Emergency Management Focused History and Physical Examination/Rapid Assessment
Responsive - Focused Unresponsive – Rapid Medical Assessment
OPQRST SAMPLE
Diabetic Emergency Management OPQRST – – – – – –
Onset Provocation Radiating Quality Severity Time
SAMPLE – – – – – –
Signs & Symptoms Allergies Medications Past Medical Hx Last oral intake Events Leading to 911 call
Diabetic Emergency Management Common Meds identified in SAMPLE: – – – – –
Insulin Diabanese Orinase Micronase Diabeta
– – – – – –
Glynase Tolinase Glucotrol Humalog Rezulin Glucophage
Diabetic Emergency Management Treatment – High flow oxygenation (BVM vs. NRB)
– Suction Oral/nasal airway
Diabetic Emergency Management Can the Patient Swallow?
If so, oral glucose PO If not, NPO, rapid transport
Oral glucose:
Raises the blood sugar, may take as long as 20 min. Indications – Altered mental status, history of diabetes, ability to swallow Page 475
Oral Glucose Drug Sheet
Oral Glucose Class: Carbohydrates Route: Oral Supplied: Squeezable Tubes Dose:
Adult: Full Tube (25-50gm) given in small doses Pediatric: 0.5 gm/kg given in small doses
Oral Glucose Cont. Drug Action: Increases Blood Glucose Level Indications:
Altered mental status caused by hypoglycemia: Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Oral Glucose Cont. Precautions:
Assure gag reflex is present
Side Effects: Aspiration Contraindications:
Absent gag reflex Patents unable to protect their airway Patents unable to swallow.
Diabetic Emergency Management Baseline Vital Signs (Q 5 or 15 min) Detailed Patient Assessment Ongoing Assessment
ABC LOC Consider other causes
Scenarios
Scenario 1 Dispatched to an unconscious person. 32 y/o female. She has a history of DM. S/S – Sudden onset of altered LOC, did not eat supper, cool moist skin, rapid thready pulse, did take insulin.
What is the level?
What is wrong with her?
Hypoglycemic Treatment – – – –
High flow oxygenation Suction Oral/nasal airway if needed Oral glucose PO if able to swallow If not, rapid transport
Scenario 2 Dispatched to a 46 y/o old male. Large patient, family brings meds to you. They include Diabeta. Patient has not been feeling well for the past day or so.
Scenario 2 S/S: Rapid and deep respirations, skin warm and dry, dry mucous membranes, patient exhibiting bizarre behavior, pulse rapid and thready, history of Polyuria, Polydypsia, and Polyphagia.
What is wrong with him?
Hyperglycemia or DKA Treatment: – High flow oxygenation – Anything else? – Rapid transport
Scenario 3 Dispatched to 80 y/o for altered mental status. History of diabetes that is normally controlled with insulin. S/S: Nausea, vomiting, irritability, altered mental status, weak, rapid pulse, and no range of motion of the right side of body.
What is wrong with her?
CVA or Stroke Treatment:
– High flow oxygenation – Anything else? – Rapid transport
Other factors to consider Intoxication Other causes of AMS
Glucometer A device used to determine blood glucose levels.
Indications for blood sugar analysis Altered Mental Status Unconscious patients of unknown cause Suspected diabetic patients
Procedure Clean finger with alcohol Wipe dry Wipe away first drop of blood Use second drop of blood
Abnormal Glucose Values Outside the normal range (60-120)
Hyperglycemia – Greater than 300 Hypoglycemia – Less than 60
Conditions Diminishing Accuracy Margin of error (1015%) Missing calibration Temperatures Outdated strips Improper technique
Insufficient sample size Contamination Wrong sample source Neonates
Review
Review IDDM
Insulin Dependant Diabetic Type I
Review NIDDM
Non-insulin Dependant Diabetic Type II
Review
3 P’s Polydipsia Ployphagia Polyuria
Review Hypoglycemia Adult
Blood sugar less than 80 mg/dL (non-diabetic) Blood sugar less than 110 mg/dL (diabetic)
Pediatric
Blood sugar less than 60 mg/dL (non-diabetic) Blood sugar less than 90 mg/dL (diabetic)
Review Hyperglycemia
>120 mg/dl
Review DKA
Diabetic Ketoacidosis Kussmaul Respirations D-stick normally > 350 mg/dl
The End
Questions?
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